Innovative Game-Aided Rehabilitation Platform for Rehabilitation of Balance in Children With Cerebral Palsy

2019 Case Medical Research  
Cerebral Palsy (CP) is one of the leading causes of disability globally. Children with CP often develop imbalance and gait abnormality resulting in mobility limitations. Early intervention with intensive, repetitive, task-oriented practice is the key to functional independence. However, often these intensive programs lack motivation and engagement that results in low adherence and discontinuation of physiotherapy. To address this gap, an innovative, computerized game-aided rehabilitation (CGR)
more » ... latform is designed for dual-task balance training. This platform provides an integrated approach to assess and treat the balance and executive cognitive functions in young children with CP. Methodology : For the known-group validity, 50 participants (25 TD and 25 CP affected children) were recruited. Comparisons were made between the two groups for DTI and task performances to evaluate the group differences. For the pilot intervention study, 16 children with CP were recruited who were randomized into two groups viz. Conventional balance training group (CBG) and Experimental group (XG). Both group received their respective therapy thrice a week for 12 weeks. The primary outcome measures were (Peabody Developmental Motor Scale-2, Gross Motor Function Classification-88, and Pediatric Balance Scale) and CGR assessment measures [COP Analysis, Visuo-Motor (VM) tracking, and Cognitive Game (CG)]. Semi-structured interview were conducted for XG participant's parents to explore their views regarding the use of CGR. iii Results: The TD group was engaged in DT whereas the CP group was struggling with balance control. For the intervention study, participants in the XG demonstrated greater improvements in all clinical and CGR outcome measures whereas the CBG demonstrated a decline in VM tracking a CG performance post-intervention. The XG parents conveyed their children's problems, their expectations, their challenges, and the positive effects of CGR balance training. Conclusion: The CGR assessment was able to differentiate between the TD and CP children's DT functional performance. The CGR balance training was found to be feasible and engaging for balance training in children with CP. The substantial improvement of balance and gross motor functions in the XG more than the CBG illustrates the effectiveness of the CGR balance training and provides baseline evidence for commencing a full-scale RCT. iv v ACKNOWLEDGEMENT Firstly, I would like to thank my advisor Dr. Tony Szturm for his ample guidance and feedback towards the completion of my thesis work. I will always be appreciative of all his positive criticism that encouraged me to be the best version of myself. I am sincerely thankful to my internal advisor Dr. Sanjay Parmar and external advisor Dr. Rasit Eskicioglu for their expert advice, inputs, support, and attention to detail throughout this process. My sincere thanks to Dr. Ruth Barclay for her guidance and support during the initial stages of my thesis formulation. My special thanks to Anuprita Kanitkar and Vedant Sakhalkar for giving a kick start to my journey in Canada and being my support pillars here. I am appreciative of all the efforts put in by the staff, faculty, students, and colleagues at SDM College of Physiotherapy for all their help and cooperation during the process. Without them, this would have been impossible to accomplish. I want to mention a special thanks to Deepthi Shetty, for being patient and cooperative in different phases of this study. I cannot thank enough to all the study participants and their parents for all their patience and co-operation during the study period. I am grateful for all the support extended by Susan Vanstone during my M.Sc. program and for helping me navigate throughout my journey at the College. I would like to extend my sincere thanks to Dr. Robert Tate for always being understanding and supportive through this journey. I am grateful to the College of Rehabilitation Science, The University of Manitoba for the Jal Tata Award 2019. I cannot conclude this acknowledgment without thanking my family members for their constant support and blessings with all the choices that I made throughout my journey. They have always encouraged me to follow my passion without any hesitance. vi DEDICATION I would like to dedicate this thesis to my beloved parents, Mr. Manoj Gunvantrai Mehta and Mrs. Rita Manoj Mehta, without whom I would not be here today. Whole-hearted thanks to my parents for being my strength and inspiration throughout the journey of my life. In addition, this journey would have been impossible without my sister and brother-in-law, Mrs. Pooja Nirav Desai, and Mr. Nirav Ashok Desai, whose endless support and admiration always motivated me. I would also like to show my gratitude to my mentor, Dr. Prabhakar Devanpalli for the constant support and encouragement in this accomplishment. Moreover, this work would have been incomplete without the support and motivation from a very special person, Mr. Akash Pinakin Shah, without whom I would have not been able to overcome the difficulties in the process of completing my thesis. It would be less to mention heartfelt thanks for all the laughter and joy you brought to the difficult times in this journey. The efforts and motivation paid off positively through this work.
doi:10.31525/ct1-nct03873441 fatcat:betjtxb7w5cjtgrg7eou4qlpca